Does serum and urine neutrophil gelatinase-associated lipocalin
?predict kidney transplant performance in the short term
Abstract: NGAL is a member of the lipocalin protein family that has diverse function but similar structure. The functions of NGAL are not clear, but it appears to be expressed in stress conditions and in tissues undergoing involution.
Varied studies have shown increased levels of plasma or urinary NGAL in diverse renal damages. The aim of this study was the serial measurement of serum and urinary NGAL within the ﬁrst week after renal transplantation in children to predict imme- diate and short-term graft function. A total of 27 patients were assessed.
These patients were classiﬁed into those with rapid reduction in serum creatinine (more than 50% reduction in serum creatinine in the ﬁrst day after transplantation) and patients with slow reduction in serum cre- atinine (<50% reduction in serum creatinine). We also assessed the absolute reduction in serum creatinine before and after transplantation. Serum and urinary NGAL on the ﬁrst day post-transplantation were higher in recipients with slow reduction in serum creatinine (urinary NGAL at the ﬁrst day: 197 ± 153 [s.e.m.] vs. 22.54 ± 8.5 [s.e.m.],
p = 0.04; serum NGAL at the ﬁrst day: 199 vs. 69.8, p = 0.003). The cutoﬀ point of serum NGAL at the ﬁrst day after transplantation for prediction of slow creatinine reduction was 174 ng/mL with a sensitivity of 100% and speciﬁcity of 95.5%. However, we did not ﬁnd association between the absolute reduction in serum creatinine before and after transplantation with the amount of serum and urinary NGAL post- transplant. Additionally, we did not ﬁnd any eﬀect of high serum and urine NGAL concentration on the graft function at the ﬁrst year post- transplant. Although it is supposed that high serum and urine NGAL may predict ischemia of graft in early phases; however, it appears that this mild ischemic injury to graft without DGF or SGF cannot aﬀect the graft function in short-term period. Further studies are needed using larger transplant recipients in pediatric age group. It is also needed to determine the eﬀects of mild ischemic injuries on the graft function in long-term period in future studies.